Recently I attended an excellent talk put on by the Australian Physiotherapy Association’s Women’s, Men’s and Pelvic Health Group by Jess Hopkins on Healthcare in the Transgender Community. I had decided I would write about this wonderful talk as Blog Number 3 in the series this week on World Continence Awareness Week: Incontinence is No Laughing Matter, as urinary incontinence is just one of the difficulties associated with the reassignment surgery. But to be honest, I would rather highlight some really big issues that we should contemplate before Trans people ever get to the reassignment surgery and the incontinence complication.

As I sat on the lounge to write this blog, one of my favourite ABC shows – Julia Zemiro’s Home Delivery – came on. And who should be on but one of Australia’s most well-known Trans women – Katherine McGregor. I encourage you to watch this episode as it reinforces the dreadful struggle that so many Trans people have to deal with through their lives and the pain they endure due to the loss of relationships, family, friends and for some careers. It is so brave of Katherine to become such a public face of this community.

This topic is so important for all health professionals and really also the general public to be well-educated about – not just for treatment of pelvic health issues for those undergoing gender reassignment but also about understanding the myriad of social and emotional issues faced by this group in our society, in our country of so-called accepting Australia. I also went to the talk hoping to learn about using appropriate language when working with Trans clients.

What is Trans?

The DSM 5 Definition of Gender Dysphoria (in adolescents or adults) is when there is a marked incongruence between one’s experienced/expressed gender and assigned gender of at least 6 months duration. This can occur with Male to Female, Female to Male and Non-binary.

Sexual orientation is an enduring pattern of romantic or sexual attraction (or a combination of these) to persons of the opposite sex or gender, the same sex or gender or to more than one gender.

Gender identity is one’s personal experience of one’s own gender. Gender identity can correlate with assigned sex at birth or can differ from it completely.

Jess works in a volunteer capacity for the Australasian Transgender Support Association of Queensland (ATSAQ) to help educate different groups about what it means to be transgender. ATSAQ was formed in 1990 to help advise and assist the transgender community in Queensland. It is run by transgenders for transgenders and provides emotional and moral support for people with Gender Dysphoria (formally known as Gender Identity Disorder) their families and friends.

Jess outlined the considerable social issues and fears facing Trans people. These include school and workplace bullying; substandard health care- incorrect diagnosis or refusal of care; fear of being outed and domestic violence repercussions; fear of being turned away and being stared at; lack of openness or information about services and invasive and inappropriate questions. The Now Australia mission is to clean up toxic workplaces. Melissa Griffiths who wrote the linked article in the Guardian is a steering committee member of Now Australia. After terrible personal experiences herself in the workplace she is adamant that workplaces free from bullying, intimidation and sexual harassment must be created. The Now Australia action creates an opportunity to do this, as well as support those who are suffering in silence.

“Our message will be heard across the land. And we will not stop until sexual harassment ends, once and for all.”

There are significant risk factors for the Trans community:

Self destructive thoughts

Family breakdown

Substance abuse

Lack of general education

Media stereotypes

Isolation

Unsupportive school environment

Some common outcomes for Trans people:

1 in 4 transgender youth attempt suicide

45% have thought about suicide

Low self esteem

Self harm

repressing feeling leading to chronic depression

I found these statistics terrifying. Especially when you hear that in Queensland 2500 transgender children are in the school system.

When Jess so articulately presented that night it made me wonder: Why do people choose to bully and disrespect Trans people when they can’t change what they are feeling and when they have no control about the body they are given at birth- about the mismatch that has occurred?

You will see next time in Part 2 of this blog that it is not cheap to have the surgery to undergo gender reassignment and the upheaval to their lives is hugely challenging – not something anyone would choose to do on a whim.

I feel so sad when contemplating the hell some children must suffer due to ignorance and a lack of understanding.

If anything you have read has triggered in any way please seek help:

Brisbane

Holdworth House Fortitude Valley. Biala Sexual Health Clinic

Lifeline: 13 11 14

Part 2 will follow on health related issues

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Thank-you for this thoughtful insight. Even though I may not be gay or transgender, it does not give me the right to bully or persecute someone who makes this decision or lives this life. I often have to use this statement to people who only strongly accept two genders and the roles society/religion give to those genders. To them, nothing else is acceptable and they cannot see why anyone could become trans. I think there are so many other factors to gender identity that need to be studied and identified. Keep the blogs going Sue. They give me hope for humanity and how physios can lead and heal with compassion, research and knowledge.